Document Detail


A randomized controlled trial of minimally invasive thyroidectomy using the lateral direct approach versus conventional hemithyroidectomy.
MedLine Citation:
PMID:  19041012     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The role of minimally invasive thyroid surgery (MITS) is currently in evolution. The aim of this study is to compare the outcomes of MITS using the direct approach through a lateral incision with conventional hemithyroidectomy (CHT) for the management of atypical thyroid nodules. METHODS: A prospective, single-blinded, randomized controlled trial involving patients presenting with atypical thyroid nodules of 3-cm diameter or less was performed. Patients were randomized to MITS through a lateral 2.5-cm incision or CHT through a traditional 5- to 6-cm cervicotomy. Pain was measured using a 7-point visual analog scale on the 1st and 10th postoperative days. Serum C-reactive protein was measured on postoperative days 1 and 10. Satisfaction with cosmetic outcome was measured at 3 months. RESULTS: One-hundred patients were randomized to undergo MITS or CHT. The 2 groups were equivalent in terms of age and thyroid nodule size. Mean operative times were longer for the MITS group (56 vs 46 min, P < .001). Mean pain scores were less in the MITS group on the 1st postoperative day (2.67 vs 3.43, P = .032). Pain scores at 10 days were equivalent (1.5 vs 1.8, P = .36). Serum C-reactive protein levels were equivalent postoperatively. At 3 months, patients undergoing MITS reported a greater mean cosmetic satisfaction score (6.3 vs 5.0, P = .002). Incision lengths measured at 3 months were 2.6 cm for MITS and 5.4 cm for CHT group, P < .001. CONCLUSION: In the management of small, atypical thyroid nodules, MITS through a direct lateral approach results in less early postoperative pain and superior cosmetic results when compared with conventional thyroidectomy.
Authors:
Mark S Sywak; Michael W Yeh; Todd McMullen; Peter Stalberg; Hubert Low; Raul Alvarado; Stan B Sidhu; Leigh W Delbridge
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Surgery     Volume:  144     ISSN:  1532-7361     ISO Abbreviation:  Surgery     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-01     Completed Date:  2008-12-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1016-21; discussion 1021-2     Citation Subset:  AIM; IM    
Affiliation:
University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, Australia. marksywak@nebsc.com.au
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MeSH Terms
Descriptor/Qualifier:
Biological Markers / blood
C-Reactive Protein / analysis
Female
Humans
Male
Middle Aged
Pain Measurement
Pain, Postoperative / diagnosis
Patient Satisfaction
Single-Blind Method
Surgical Procedures, Minimally Invasive
Thyroid Nodule / pathology,  surgery*
Thyroidectomy / methods*
Chemical
Reg. No./Substance:
0/Biological Markers; 9007-41-4/C-Reactive Protein

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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